| NPI | 1326634924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.161861) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH QMHS.Masters) |
| 175T00000X Peer Specialist (Licence: OH APS.002206) | |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2023-05-10 |